Recurrent Adult Sacrococcygeal Teratoma Developing Adenocarcinoma: A Case Report and Review of Literatures

Sacrococcygeal teratomas (SCT) are most commonly seen in infants and children but are rare in adults. Most adult SCT are benign and mature with a minority of tumors having immature components or overt malignancy. Here, we report a 65-year-old female with a SCT developing adenocarcinoma. The patient was diagnosed with benign sacrococcygeal cystic teratoma on her initial hospital visit and was treated with surgical resection. She was followed up postoperatively and was noted to have a markedly elevated CA 19-9 level 13 months after the surgery. Radiological and clinical examination revealed thickening of the perirectal soft tissues, located near the inferior portion of her previous incision site. Histological evaluation of the lesion showed invasive, moderately differentiated adenocarcinoma. Immunohistochemical staining results were suggestive, but not diagnostic, of anal gland adenocarcinoma. This case report expands the knowledge regarding an adenocarcinoma arising from a previously benign, adult SCT.

Superomedial Reduction Mammoplasty Affects Patients’ Ability to Breastfeed in a Distinct Manner: A Multicenter Study of 303 Patients

Background Breast reduction using the superomedial technique can relieve symptoms related to breast hypertrophy; however, as the lateral and inferior portion of the breast parenchyma is removed and displaced, reduction mammoplasty may lead to an impaired ability to breastfeed. Objectives To assess the patient's ability to breastfeed after superomedial reduction mammoplasty. Methods This was a cross-sectional study including patients treated with superomedial reduction mammoplasty between January 2009 and December 2018 at two tertiary hospitals in Denmark. Patients were stratified into two cohorts, depending on whether they had childbirth before or after their reduction mammoplasty. Patients were sent specific questionnaires regarding maternity, breastfeeding before and after reduction mammoplasty, nipple sensitivity, and current demographic information. Operative details were retrieved from electronic medical records. Results We identified 303 patients eligible for this study (37 patients giving birth after and 266 before reduction mammoplasty). Fewer patients were able to breastfeed exclusively for the recommended six months after reduction mammoplasty (2/37 = 5.41%) compared to before (92/266 = 34.59%, p<0.05). Also, fewer patients were able to breastfeed at all after reduction mammoplasty (18/37 = 48.64%) compared to before mammoplasty (241/266 = 90.60%, p<0.001). Patients unable to breastfeed after reduction mammoplasty had less nipple sensitivity and more breast tissue excised (p<0.05). Conclusions Superomedial reduction mammoplasty seems to impair the patient's ability to breastfeed exclusively for the recommended 6 months. Patients of childbearing age considering reduction mammoplasty should be made aware that reduction mammoplasty reduces their breastfeeding capacity.

Short duration Vectorcardiogram based inferior myocardial infarction detection: class and subject-oriented approach

Myocardial infarction (MI) happens when blood stops circulating to an explicit segment of the heart causing harm to the heart muscles. Vectorcardiography (VCG) is a technique of recording direction and magnitude of the signals that are produced by the heart in a 3-lead representation. In this work, we present a technique for detection of MI in the inferior portion of heart using short duration VCG signals. The raw signal was pre-processed using the median and Savitzky–Golay (SG) filter. The Stationary Wavelet Transform (SWT) was used for time-invariant decomposition of the signal followed by feature extraction. The selected features using minimum-redundancy-maximum-relevance (mRMR) based feature selection method were applied to the supervised classification methods. The efficacy of the proposed method was assessed under both class-oriented and a more real-life subject-oriented approach. An accuracy of 99.14 and 89.37% were achieved respectively. Results of the proposed technique are better than existing state-of-art methods and used VCG segment is shorter. Thus, a shorter segment and a high accuracy can be helpful in the automation of timely and reliable detection of MI. The satisfactory performance achieved in the subject-oriented approach shows reliability and applicability of the proposed technique.

Primary Sternal Cleft Repair in First Week of Life

We present a full-term neonate with a postnatal diagnosis of a sternal cleft. Cardiac evaluation was otherwise remarkable for a patent ductus arteriosus and patent foramen ovale. Computed tomography scan confirmed the absence of a sternum except for a small inferior portion, including the xyphoid process. The patient underwent primary repair at five days of age through a midline incision where an absence of pericardium anteriorly was noted. She was extubated successfully the next day and discharged home on postoperative day 3. On follow-up examination, her sternum has been healing well without any clinical concerns. We advocate early repair of such defects in order to allow primary closure in a tension-free manner.

Identification and Morphogenesis of Vestibular Atrial Septal Defects

Background: The vestibular atrial septal defect is an interatrial communication located in the antero-inferior portion of the atrial septum. Reflecting either inadequate muscularization of the vestibular spine and mesenchymal cap during development, or excessive apoptosis within the developing antero-inferior septal component, the vestibular defect represents an infrequently recognized true deficiency of the atrial septum. We reviewed necropsy specimens from three separate archives to establish the frequency of such vestibular defects and their associated cardiac findings, providing additional analysis from developing mouse hearts to illustrate their potential morphogenesis. Materials and methods: We analyzed the hearts in the Farouk S. Idriss Cardiac Registry at Ann and Robert H. Lurie Children’s Hospital in Chicago, IL, the Van Mierop Archive at the University of Florida in Gainesville, Florida, and the archive at Johns Hopkins All Children’s Heart Institute in St. Petersburg, Florida, identifying all those exhibiting a vestibular atrial septal defect, along with the associated intracardiac malformations. We then assessed potential mechanisms for the existence of such defects, based on the assessment of 450 datasets of developing mouse hearts prepared using the technique of episcopic microscopy. Results: We analyzed a total of 2100 specimens. Of these, 68 (3%) were found to have a vestibular atrial septal defect. Comparable defects were identified in 10 developing mouse embryos sacrificed at embryonic data 15.5, by which stage the antero-inferior component of the atrial septum is usually normally formed. Conclusion: The vestibular defect is a true septal defect located in the muscular antero-inferior rim of the oval fossa. Our retrospective review of autopsied hearts suggests that the defect may be more common than previously thought. Increased awareness of the location of the defect should optimize its future clinical identification. We suggest that the defect exists because of failure, during embryonic development, of union of the components that bind the leading edge of the primary atrial septum to the atrioventricular junctions, either because of inadequate muscularisation or excessive apoptosis.

THU0598 A CASE REPORT ON A RARE PRESENTATION OF GOUT INVOLVING THE PATELLAR TENDON

Background:Gout is an inflammatory arthropathy associated with long-standing hyperuricemia. The first metatarsophalangeal joint is the most commonly involved joint, although gout is often polyarticular. Involvement of tendons has been described, but is rare. We report a case of gout involving the inferior portion of the patellar tendon.Objectives:A Case report to highlight a rare presentation of gout.Methods:A 50 year old male presented to the Rheumatology emergency clinic with severe right knee pain, unable to weight bear. He had been recently diagnosed with Sero negative Inflammatory Arthritis and treated with Methotrexate for 4 months. He had presented one week previously to the general medical team on call with similar but less severe pain. He was discharged on steroids, which were of no significant benefit. The pain progressively worsened to the extent that he was not able to bear weight on the right knee. He denied pain or swelling of any other joint.On examination of his right knee, it was extremely tender, slightly erythematous with increased local temperature. There was no arthritis in any other joint and there were no tophi. Joint aspiration was attempted but there was no fluid.He was admitted with query Septic arthritis and started on intravenous antibiotics. Uric acid level was 583u/l. US of the knee showed small fluid in the pre patellar bursa.Orthopaedic team was involved and he was taken to the operation theatre. Knee joint was aspirated which was negative for crystals and there was no growth on cultures.He ultimately had an MRI of his right knee which showed significant soft tissue oedema and abnormality in the patellar tendon.MRI of Rt knee showing marked soft tissue edema (arrow)Targeted US of the knee done by a consultant rheumatologist showed significant changes in the inferior portion of the patellar tendon consistent with infiltration. The external tendon boundaries were normal. It was thought to be likely that these represented gouty tophi.USG of the rt knee showing infiltrates in the inferior portionof patellar tendon with increased Doppler flowHe went on to have a patellar tendon biopsy which has shown changes consistent with gout.He was started on Colchicine 0.5mg bd leaving the hospital and Allopurinol was started two weeks later.Results:He was seen in the clinic as follow up with complete resolution of his pain. Methotrexate was stopped. He has reported no flares and Allopurinol is being titrated up to achieve serum uric acid concentration <300u/l.Conclusion:The most important finding in this case report is that interstitial gouty tophi of the patellar tendon, can cause debilitating symptoms and can prove difficult to diagnose and treat.References:[1]Roddy E, Choi H K. Epidemiology of gout. Rheum Dis Clin North Am. 2014;40(02):155–175.[2]Forbess L J, Fields T R. The broad spectrum of urate crystal deposition: unusual presentations of gouty tophi. Semin Arthritis Rheum. 2012;42(02):146–154.Disclosure of Interests:None declared

Intrascrotal lipoblastoma in adulthood

This case report describes the case of a 37-year-old man that noticed an intrascrotal right mass with 1 month of evolution. During physical exam presented with a large mass at the inferior portion of the right testicle, clearly separated from the testicle, with a tender consistency and mobile. An ultrasound was performed that showed a solid and subcutaneous nodular lesion, extra testicular, heterogeneous, measuring 7.2 cm. Pelvic magnetic resonance imageMRI showed a lesion compatible with a lipoma. The patient was subjected to surgical excision of the lesion by scrotal access, having histology revealed a lipoblastoma (LB) of the scrotum. Histological diagnosis was obtained by microscopic characteristics (well-circumscribed fatty neoplasm) and immunohistochemistry (stains for CD34, S100 protein and PLAG1 were positive; stains for MDM2 and CDK4 were negative). LB is extremely rare after adolescence in any location, being this first described case of intrascrotal LB described in adulthood.

Tropidogyne lobodisca sp. nov., a third species of the genus from mid-Cretaceous Myanmar amber

The fossil flower described here is the third species of Tropidogyne to have been collected from mid-Cretaceous amber deposits in the Hukawng Valley of northwestern Myanmar. The flower of Tropidogyne lobodisca differs from the 2 previously described species, T. pikei and T. pentaptera, in lacking stamens and having a 5-lobed nectar disc covering the apex of the ovary. Its 2 slender, curved, attenuate styles are like those of T. pentaptera in being stigmatic along the adaxial surface. The new species has 5 spreading, reticulately-veined sepals, a generic character of Tropidogyne. An unusual, probably teratological, feature is the presence of 2 sepal-like staminodes on one side of the flower, inserted at the base of the nectar disc where stamens would otherwise be found. The inferior portion of the pistil is obconic, with 5 distinct veins that connect to the mid-nerves of the sepals.

Strombothelya gen. nov., a fossil angiosperm with two species in mid-Cretaceous Myanmar amber

Strombothelya, a new genus of fossil angiosperms from Myanmar amber deposits, is represented by 2 flowers that are here described as separate species. Flowers of Strombothelya have 5 spreading, more or less distinctly veined sepals. Petals are absent. There are 10 inwardly arching stamens and a half-inferior ovary, whose broadly conic superior portion terminates in 1 or 3 stout, columnar, apically truncate styles. The superior portion has a papillate surface that was probably nectarifer-ous. The inferior portion of the ovary in both species is obconic and 5- or 10-ribbed. The fossils are comparable in certain respects to the genus Tropidogyne, described earlier from the same amber deposits. The 3 species of Tropidogyne have flowers with 5 or 10 stamens and 2 or 3 slender, curved, acutely-tipped styles. The inferior portion of the ovary is strongly 10-ribbed, while the superior portion is flat or cushion-shaped and bears a lobed nectar-disc. Strombothelya and Tropidogyne inhabited a Cretaceous araucarian rainforest, which may have been located in the Southern Hemisphere continent of Gondwana.